Why LASI did not endorse the new definitions of sepsis published today in JAMA拉丁美洲全身性感染研究所为何不认可《JAMA》今日发布的全身性感染新定义Today, JAMA published the new sepsis definitions, an initiative of the Society of Critical Care Medicine (SCCM) and the European Society of Intensive Care Medicine (ESICM). LASI was invited to endorse the document. However, we declined to do so, as did other major American societies such as the American College of Chest Physicians and the American College of Emergency Physicians. 今日，JAMA发布了由美国危重病医学会(SCCM)及欧洲危重病医学会(ESICM)发起制定的全身性感染新定义。LASI应邀签署文件。然而，与美国胸内科医师学院(ACCP)及美国急诊医师学院等美国的其他主要学会一样，我们拒绝署名。 We sent a letter today to JAMA with the reasons for our refusal. We decided it was worth sharing the gist of the letter with you; greater details will follow the letter's acceptance. 今天，我们给JAMA编辑部写信说明了拒绝的理由。我们认为有必要与大家分享信件的要点；待信件被接收后再讨论具体细节。 1. We found it regrettable that the group of experts selected by SSCM and ESICM did not include any member from the low- and middle-income countries (LMIC), as sepsis care is different in these settings. Unfortunately, receiving endorsement from some societies in the LMIC did not solve this issue, since to refuse endorsement could be difficult given the existing political relationships. 我们很遗憾的发现，SCCM与ESICM挑选的专家组并未包括中低收入国家(LMIC)的任何成员，而在这些地区全身性感染的治疗存在很大差异。遗憾的是，在现有的政治关系下拒绝署名可能非常困难，因此LMIC的某些学会可能署名认可这一定义，但这样并不能解决上述问题。 2. The need of 2 points in SOFA or 2 components of qSOFA to define sepsis will select a more severely ill population. This might be of interest to the more privileged countries, nowadays suffering from over-sensitivity, but it is detrimental to the interests of LMIC, where we are trying to raise awareness about this problem. Patients with hypotension or with a reduced level of consciousness will be classified as 'uncomplicated infection'. 满足SOFA评分2分或者qSOFA评分2分的患者病情往往更加严重。某些发达国家对这一定义很感兴趣，因为它们深受原有标准敏感性过高的损害；然而，这对于LMIC却是有危害的，因为我们正在设法提高对这一问题的认知度。低血压或意识水平降低的患者将归为“非复杂性感染”。 3. Any process of improving quality of sepsis care in the LMIC should focus on early detection of possible infection based on SIRS criteria and the presence of any organ dysfunction. So, we cannot agree with the use of qSOFA as a screening tool as suggested by figure 2. These patients would be already too sick. 改进LMIC全身性感染诊疗质量的任何努力，都应当强调根据SIRS及器官功能障碍的标准，早期发现可能的感染。因此，我们不赞成使用图2中建议的qSOFA评分做为筛选工具。这些患者可能病情已经非常严重。 4. Elevated lactate levels (even if > 4 mmol/L) are no longer part of organ dysfunction criteria to define sepsis. According to the new concept, high lactate levels will be used only as one of the criteria to define septic shock. Thus, the new criteria assume that patients with hyperlactatemia and without hypotension have no higher risk of death. We strongly disagree that a patient with lactate higher than 4 mmol/L will have only 'uncomplicated infection'. 乳酸水平升高（即使> 4 mmol/L）不再作为器官功能障碍标准诊断全身性感染。根据最新概念，乳酸水平升高只是诊断感染性休克的标准之一。因此，新的诊断标准设想不合并低血压的高乳酸血症患者死亡风险并不增加。我们强烈反对认为乳酸水平> 4 mmol/L的患者仅为“非复杂感染”。 We would like to invite you all to a careful reading of the new definitions and to join us in the request for proper reassessment. 希望各位能仔细阅读新定义，与我们共同要求进行重新评定。 （“来源：CSCCM”） |
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